From the very beginning the occurrence of spontaneous recanalization, the growing together of the severed ends of the seminal ducts, has been one of the main problems associated with vasectomy. As long ago as the 1950s it became clear that if one simply tied off the seminal duct there was virtually always recanalization, and even after severing in several places there was also spontaneous recanalization. If a length of 3 cm was removed, but the sheath of the duct remained intact, the same thing happened. Recanalization did not occur if the sheath was also removed.

Recanalization is still a problem, and is found in between 1 in 1,000 and і in 2,000 men who have ‘had themselves fixed’. The risk is higher if after the vasectomy a spermagranuloma develops. A granu­loma is created by leakage of spermatozoa on the testicle side, despite effective ligature of the end of the seminal duct. Tying off is actually not all that easy, since the seminal duct has a thick wall of muscle, so that there is a risk that the stitch will be pulled too tight and will sever the duct. Partly for this reason many urologists decide for reasons of safety to cauterize the tied-off ends. It is also a good idea to sew a section of different tissue between the two ends, preventing them from coming into contact.

The complications of vasectomy are quite often underestimated. Whichever way you look at it, vasectomy is an odd procedure; if a sur­geon were to remove a section of intestine and close off both ends, he or she would be immediately committed to a lunatic asylum, if neces­sary by force. . .

From puberty to death millions of sperm cells pass along these tubes that resemble liquorice shoelaces. After vasectomy the ‘little creatures’ can no longer do this. Upstream of the blockage all is woe and affliction, with dead and dying spermatozoa, and of course that can lead to ailments: a painfully swollen epididymis, pain in ejaculat­ing, the previously mentioned spermagranuloma and tears in the wall of the extremely long tube which the epididymis in fact is. Sperm cells may leak through those tears, causing inflammation and antibody formation, since spermatozoa are regarded as basically alien, having only half the normal number of chromosomes.

In the past few decades surgeons and urologists have perhaps made things a little too easy for themselves in failing to dispense complete information on the possible downside of vasectomy. Many men would be deterred if they were told that approximately 5 per cent of sterilized men have chronic testicular pain. Men who already suffer from testi­cular pain should certainly not have themselves sterilized. Other reasons not to be sterilized include childlessness, a serious or chronic ill­ness in one’s partner and the lack of a permanent relationship. In addition anyone contemplating the procedure should be warned of continued bleeding and/or haemorrhaging (10% to 20% chance) and infection (2% to 10% chance).